Viral Hepatitis Among People Who Use or Inject Drugs

Risks

Certain populations, including people who use or inject drugs, have an increased risk for contracting viral hepatitis.

Injection drug use and hepatitis A

Hepatitis A is transmitted through the fecal-oral route. While hepatitis A can affect anyone, certain groups are at greater risk for infection. Recent person-to-person transmission of hepatitis A has occurred across the country, and frequently among people who use drugs (PWUD). In some cases, people can experience severe complications, hospitalization, and even death. CDC recommends that people who use or inject drugs be vaccinated against hepatitis A.

Injection drug use and hepatitis B

Hepatitis B virus (HBV) is a bloodborne pathogen and can also be transmitted through exposure to other body fluids. PWID are at risk for HBV infection through the sharing of syringes and/or any other equipment used to prepare and inject drugs.

CDC published updated recommendations for hepatitis B screening and testing in 2023 that are complementary to the 2022 Advisory Committee on Immunization Practices (ACIP) vaccine recommendations for hepatitis B.

The updated recommendations include hepatitis B screening for all adults once in their lifetime and hepatitis B vaccination for all adults aged 19-59 years.

Injection drug use and hepatitis C

Hepatitis C virus (HCV) is also a bloodborne pathogen. The number of acute hepatitis C cases has doubled since 2015. Among risk behaviors and exposures identified for reported cases of acute HCV infection in 2022, injection drug use was most commonly reported. CDC recommends one-time screening for all adults, testing for anyone who has ever injected drugs, regardless of age, and periodic testing if risk persists.

Harm reduction

SSPs are community-based prevention programs. The purpose is to:

• Increase access to harm reduction services for people who use or inject drugs or have a history of injecting drugs.
• Reduce the incidence of infectious disease and other complications of using injection drugs.

These organizations provide a range of harm reduction services including:

• Access to sterile syringes and disposal of used injection equipment.
• Testing and vaccination for infectious diseases.
• Linkage to treatment for infectious diseases.
• Linkage to treatment for substance use disorder.

SSPs are associated with an estimated 50% reduction in HIV and HCV incidence.

Nearly 30 years of research show that comprehensive SSPs are safe, effective, and cost-saving, do not increase illegal drug use or crime, and play an important role in reducing the transmission of viral hepatitis, HIV, and other infections.

Learn more about what CDC is doing to address viral hepatitis in this population.

Resources

These resources from CDC and other national organizations can help clinicians learn more about preventing and treating viral hepatitis among people who use or inject drugs.

Scientific guidelines and recommendations

Hepatitis A

• This MMWR describes ACIP's recommendations for hepatitis A prevention.

Hepatitis B

• This MMWR provides CDC's recommendations for universal hepatitis B screening and testing.
• This MMWR describes ACIP's recommendations for universal hepatitis B vaccination.
• This MMWR describes ACIP's recommendations for hepatitis B prevention.
• This MMWR provides recommendations for identification and management of chronic hepatitis B.

Hepatitis C

• This MMWR provides CDC's recommendations for hepatitis C screening among adults.

All viral hepatitis

• This MMWR outlines federal guidance for viral disease prevention among PWUD.

CDC resources

• Syringe Services Programs (SSPs) are community-based prevention programs that can provide a range of services, including facilitating safe disposal of used needles and syringes.
• CDC provides an overview of HIV prevention among PWID.
• CDC summarizes HIV cluster detection and response (CDR), which identifies communities affected by rapid HIV transmission. This resource includes:
  • A PDF providing comprehensive recommendations for state and local health departments for handling HIV and hepatitis C outbreaks.
  • A PDF checklist for state and local health departments outlining considerations for HIV and hepatitis C outbreak management.
• This collection of resources from CDC summarizes prevention of opioid overdoses.
• This resource from the Tennessee Department of Health is an example of an HIV and HCV response plan that can be utilized by other health departments.

Federal resources

• National Institute on Drug Abuse (NIDA) advances science on drug use and addiction to improve individual and public health.
• Substance Abuse and Mental Health Services Administration (SAMHSA) is the agency within the United States Department of Health and Human Services that leads public health efforts to advance the behavioral health of the nation.

Other organizations’ resources

• American Association for the Treatment of Opioid Dependence (AATOD) is a national nonprofit that works to expand access to quality opioid use disorder treatment services.
• World Health Organization (WHO) provides guidance on hepatitis B and hepatitis C prevention among PWID.
• The National Association of County Health Officials (NACCHO) supports local health departments in harm reduction programs.

Communication resources

These resources from CDC can help clinicians talk to their patients about preventing and treating viral hepatitis.

Posters, digital tools, and social media

For more, see all posters for PWID.

Resources for PWUD and PWID

• Hepatitis A Outbreak Educational Materials
• This wallet-sized vaccine card can help patients and service providers track hepatitis A and hepatitis B vaccine dosage over time.
• PWID Fact Sheet (archived)
  • Spanish (archived)