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.
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.
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.
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