A study was carried out to determine whether hepatitis A virus (HAV) can be detected in the stools of patients hospitalized for HAV infection. Acute phase samples of whole blood and stool, as well as completed questionnaires, were obtained from 31 patients hospitalized at any of 13 hospitals in the Phoenix metropolitan area. Blood specimens were tested for hepatitis B surface antigen (HBsAg), IgG antibody to HAV (IgG anti-HAV), and IgM antibody to HAV (IgM anti-HAV). Stools were tested for HAV by radioimmunoassay. Five patients (16.1%) had acute hepatitis B, five (16.1%) had acute non-A/non-B hepatitis, and 21 (67.7%) had acute hepatitis A. Of these 21 patients with acute hepatitis A, 11 (52.4%) were found to have HAV in their stools. These results confirm the potential for infectivity of stools of patients hospitalized for hepatitis A and emphasizes the need for caution when dealing with such stools.

Outbreaks of hepatitis in day-care centers in Maricopa County, Arizona, were studied over a two-year period to learn which center characteristics affected the spread of hepatitis A. Of the 279 licensed center, 85 (30%) had outbreaks of hepatitis affecting three or more families. Outbreaks occurred in 63% of centers enrolling infants younger than one year of age, 32% of centers enrolling children one year of age or older, and 2.5% of centers enrolling children two years of age or older (P less than 0.0001). Outbreaks were also significantly more frequent in large centers enrolling greater than or equal to 51 children, centers open greater than 15 hours per day, and centers operated for profit. The introduction of hepatitis into a center was related strongly to the number of hours open and to the size and age enrollment, but the spread of hepatitis was related solely to the presence of children younger than two years of age. These data strongly link the spread of hepatitis A in day-care centers to the presence of very young children and provide a framework for designing disease-control strategies.

In September 1978, cases of hepatitis B in two patients treated by the same dentist led to investigation of a dental practice in Baltimore, Maryland. The dentist had had acute hepatitis B in June 1978 and had remained positive for hepatitis B surface antigen and hepatitis B e antigen over the ensuing 6 months. He had continued to work while infected, wearing surgical gloves to minimize the risk of transmitting infection. Serologic follow-up of 764 patients showed that a total of six patients, three of whom were symptomatic, had developed hepatitis B infection after dental treatment. All six were among a group of 395 patients treated before the dentist began wearing gloves. In this group, patients having highly traumatic dental work (attack rate 6.9%) were at significantly higher risk than patients having either less traumatic work (attack rate 0.5%) or nontraumatic work (attack rate = 0, p less than 0.02). None of 369 patients treated only when the dentist wore gloves became infected, suggesting that gloves could reduce the risk of virus transmission by the dentist.

We investigated the spread of viral hepatitis in day-care centers in Maricopa County, Ariz. Over a 10-month period, 398 (40 per cent) of 1008 reported cases of hepatitis Type A or viral hepatitis of unspecified type occurred in persons closely associated with day-care centers. Outbreaks of hepatitis comprising 310 cases were identified in 30 of 308 centers in the county. In 28 outbreaks investigated, the majority of symptomatic cases occurred in household contacts or close relatives of children who attended day-care centers, with 16 per cent of the cases occurring in children who attended the centers and 15 per cent occurring in employees. Hepatitis in both employees and household contacts was strongly related to contact with children one to two years of age who attended the centers (P less than 0.001). Day-care centers appear to be important in the spread of hepatitis A in the United States.

Journal Article Comparative Risk of Hepatitis B among Physicians and Dentists Get access J. L. Smith, J. L. Smith Bureau of Epidemiology Phoenix Laboratories Division Please address requests for reprints to Dr. J. L. Smith, Bureau of Epidemiology, Phoenix Laboratories Division, Center for Disease Control, 4402 North Seventh Street, Phoenix, Arizona 85014. Search for other works by this author on: Oxford Academic PubMed Google Scholar J. E. Maynard, J. E. Maynard Bureau of Epidemiology Phoenix Laboratories Division Search for other works by this author on: Oxford Academic PubMed Google Scholar K. R. Berquist, K. R. Berquist Bureau of Epidemiology Phoenix Laboratories Division Search for other works by this author on: Oxford Academic PubMed Google Scholar I. L. Doto, I. L. Doto Bureau of Epidemiology Phoenix Laboratories Division Search for other works by this author on: Oxford Academic PubMed Google Scholar H. M. Webster, H. M. Webster Bureau of Epidemiology Phoenix Laboratories Division Search for other works by this author on: Oxford Academic PubMed Google Scholar M. J. Sheller M. J. Sheller Bureau of Epidemiology Phoenix Laboratories Division Search for other works by this author on: Oxford Academic PubMed Google Scholar The Journal of Infectious Diseases, Volume 133, Issue 6, June 1976, Pages 705–706, https://doi.org/10.1093/infdis/133.6.705 Published: 01 June 1976

To identify occupational categories and work areas of possible risk for acquisition of nosocomial hepatitis B by hospital personnel, serologic sampling for hepatitis B surface antigen (HBSAg) and antibody (anti-HBS) by radioimmunoassay was carried out in 513 employees of a large metropolitan hospital serving predominantly indigent patients. HBSAg was detected in 0.7%, HBSAg and anti-HBS in 0.4%, and anti-HBS in 13.3% of the study population. No significant difference in seropositivity was noted between sexes. Furthermore, neither exposure to patients with hapatitis nor previous blood transfusion correlated with serologic evidence of hepatitis B infection. However, frequency and intensity of exposure to blood products was associated with serologic evidence of infection: 18.9% of those with frequent blood contact were positive for HBSAg or anti-HBS, compared with 11.4% of those without blood product exposure (p less than .05). Direct patient contact, apart from blood exposure, did not appear operative as a major factor in hepatitis B transmission in this population. Accordingly, occupational categories and work areas with highest risk for acquisition of nosocomial hepatitis B were those with greatest blood exposure.

Further to clarify the epidemiology of dialysis-unit hepatitis, serological sampling for hepatitis-B antigen (HBAg) and antibody (HBAb) by radioimmunoassay was carried out in four hæmodialysis units with no epidemic history of hepatitis. 34% of patients and 36% of staff were seropositive for HBAg, HBAb, or both. Family contacts of patients and staff showed no significantly greater infection prevalence (13%) than did any of the three control populations, but spouses of seropositive index cases (patients or staff) did seem to be at higher risk for secondary infection with type-B viral hepatitis. Although transfusion of blood products correlated with infection prevalence, other risk-factor analysis suggested the dialyser to be a potent factor in disease transmission.