Deinstitutionalized mentally retarded hepatitis-B surface antigen carriers in public school classes: a descriptive study.

Abstract

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.

Hepatitis B and C in institutions for individuals with intellectual disability

“…The prevalence of HBV in individuals with intellectual disability is much higher than in the general population as a result of factors related to intellectual disability, institutionalization and behaviour. The high transmission rate amongst individuals with intellectual disability is thought to be caused by the following behavioural features ( Bakal et al . 1980 ; Cancio‐Bello et al .…”

Hepatitis B in the non‐residential mentally handicapped population

“…Factors which have been implicated in this process include poor hygiene, enabling direct contact of blood or serum by scratching or picking of sores, and sharing of towels, razors and toothbrushes. Further behavioural factors may include affectionate/kissing behaviour, biting and sexual activities (Clarke et al 1984;Bakal et al 1980;Szmuness et al 1978;Wagemans & Zielhuis 1985;Perrillo et al 1986. The ability of Down's syndrome clients to retain the carrier state is also likely to promote the spread of the virus in closed commvinities (Chaudhary et al 1977).…”

Mentally retarded hepatitis-B surface antigen carriers in NYC public school classes: a public health dilemma.

“…'9-23 There may be substantial differences in infectivity between individual HBsAg carriers, reflected in differences in personal and social behaviors as well as in serological markers. 2 The NYC Health Department believed that a potential for transmission at school existed because of: observed classroom behaviors, the opinions of a group of recognized experts in the field, and empirical data from analagous exposure situations published in the medical literature. We were also concerned that silent classroom infection might lead to subsequent intrafamilial HBV transmission.…”

“…This study, described in an accompanying paper, showed that the majority of classroom contacts of the HBsAg carriers were immunologically susceptible to infection, and that conditions and behaviors in BCRMD classes might promote hepatitis-B virus (HBV) transmission. 2 In December 1977, the Health Commissioner convened a task force to review the problem. The task force included NYCHD physicians, the New York State and City chief epidemiologists, and five experts in the field of hepatitis epidemiology.…”