Twenty-seven of 33 formerly institutionalized retarded HBsAg carriers exhibited behaviors which might facilitate viral transmission in classrooms where they had been placed with retarded susceptibles. Classroom conditions included lack of handwashing facilities and frequent failure to inform staff of the presence of such carriers in their classes. A seroIn 1977, placement of mentally retarded children, many of whom are hepatitis-B surface antigen (HBsAg) carriers, into public schools from institutions caused concern among parents, teachers, and New York City Health Department (NYCHD) officials about the hazards of transmission of the virus to susceptible students. The controversy that ensued is described in an accompanying commentary.'HBsAg is found on the surface or outer shell of the double-shelled hepatitis-B virus (HBV) and on accompanying unattached particles which have not been incorporated into complete virions.2 It is considered a marker for the presence of HBV; HBsAg carriers are equivalent to HBV carriers in almost all cases. The "e" antigen (HBeAg) is associated only with complete virions and is a marker for increased infectivity in persons with HBsAg-positive sera.3A4 At the time of this study, the significance of HBeAg was not yet completely understood and a routine assay for this antigen was not available. Thus, we were able to test only for the presence of HBsAg and the antibody to HBsAg, anti-HBs.Acutely or chronically viremic individuals are sources of HBV for others, but mere exposure to an HBsAg-positive individual does not guarantee subsequent transmission of the virus.4 Transmission probably depends on the amount of infectious virus transferred to the susceptible individuals.
The placement of retarded children who have been institutionalized and are asymptomatic hepatitis-B surface antigen carriers into public school classes for the retarded has caused controversy and presented the New York City Health Department with an unusual medical-ethical dilemma.In this situation, the cost of interfering with deinsti-
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