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© 1995 Oxford University Press

research-article

An Outbreak of Hepatitis A among Irish Haemophiliacs

ZACHARY JOHNSON*, LELIA THORNTON*, ANNE TOBIN**, EMER LAWLOR{dagger}, JOAN POWER{ddagger}, IRENE HILLARY§ and IAN TEMPERLEYboxV

* Eastern Health Board, Health Information Unit, Dr Steevens Hospital Dublin 8, Ireland
** Department of Clinical Medicine, St James's Hospital Dublin 8, Ireland
{dagger} Blood Transfusion Service Board Mespil Road, Dublin 2, Ireland
{ddagger} Blood Transfusion Service Board Cork, Ireland
§ Virus Reference Laboratory, University College Belfield, Dublin 4, Ireland
boxV National Haemophilia Treatment Centre, St James's Hospital Dublin 8, Ireland

BACKGROUND: An outbreak of hepatitis A (HAV) occurred in 1992 in Irish haemophilia A patients treated with high purity solvent-detergent (SD) treated factor VIII. Similar outbreaks were reported in Italy, Germany and Belgium. The aim of this study was to investigate the outbreak, and to test the hypothesis that it was caused by exposure to SD-treated factor VIII.

METHODS: A case-control study was started in early 1993. Haemophilia A cases with acute HAV (n = 29) were compared with haemophillia A controls for exposure to SD-treated factor VIII and other environmental factors. Details of factor VIII usage were obtained from the National Haemophillia Register and environmental data were obtained by a telephone-administered questionnaire. The response rate was approximately 90%.

RESULTS: The Incidence of acute HAV infection among haemophillia A patients exceeded the notified national incidence of HAV by a factor of approximately 300. The incidence was higher in younger patients and those with more severe bleeding disorders. Contact with hepatitis, with children, and exposure to factor VIII were associated with increased risk. The association with factor VIII was the strongest risk factor after controlling for other factors (odds ratio = 27.6, 95% confidence Interval [Cl] 6.5–117.3). A dose-response effect was demonstrated.

CONCLUSIONS: Although person-to-person transmission is likely to have caused a few of the cases, the results of our investigation suggest that the major contributing factor was exposure to certain batches of SD-treated factor VIII.

Keywords Hepatitis A, haemophilia A, factor VIII

Revised 1 November 1994


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