JAMA. 1975 Dec; 234(9): 930-4.

Hepatitis B in Nuremberg, Germany. Epidemiology of a drug-associated epidemic. Among US Army soldiers.

Cates W, Warren JW.

Beginning in 1971, acute viral hepatitis was epidemic among US soldiers stationed in Europe, with a total of over 8,700 cases reported between 1971 and 1974. Hepatitis B surface antigen (HBsAg) determinations suggest a predominance of hepatitis B. In the Nuremberg area, primary association was with the illicit use of drugs. This association was demonstrated by a chronologic relationship between measurable community drug use and the number of hepatitis admissions three to six months later and by a case-control study. Parenteral drug use and, to a lesser degree, cannabis smoking appeared to be factors in disease transmission. Sharing of illicit drugs with a hepatitis contact, whether parenterally or orally, was associated with increased risk of contracting the disease.