Hepatitis A among health workers in Paris hospitals

Abstract

To design a vaccination strategy against hepatitis A among hospital employees, we carried out a serological survey of hepatitis A virus (HAV) infection in 10 university hospitals in the Paris area. Subjects under 60 years of age were consecutively enrolled by occupational health services and tested for IgG to HAV by ELISA. Of the 1,516 subjects recruited, 926 were health workers (HW), 322 clerks, and 268 cooks or kitchen employees. Among HW and clerks the HAV seroprevalence was 53.8% (95% CI: 44.0-65.6), increasing with age and being higher among employees of African or Caribbean origin than those from Europe (83.6% vs 45.6%, P < .001). Age correlated closely with the duration of hospital work, so only age was taken into account for further analysis. The HAV seroprevalences among HW and clerks originating from Europe were close (46.8% vs 42.6%) and remained so after adjustment for age. HAV seroprevalences in HW caring for adults and those caring for children were also similar (45.2% vs 40.1%). Seroprevalence was higher in assistant nurses than in nurses (51.3% vs. 39.8%, P < .02). Among cooks and kitchen employees, 53.4% were HAV-seropositive. This study shows that hospital employees need not routinely be vaccinated against HAV; the decision should be taken by the occupational physician according to the type of work, but should be routine for cooks and kitchen employees. The need for prevaccinal screening for anti-HAV should be assessed in the light of employees' geographical origin and age.

Enormous Dose of Insulin with Suicidal Intent

“…In 1954 Bluthner (4) reported such a case of overdose and at the same time referred to the six cases already published [l, 2 (2 cases), 7, 8 (2 cases)]. In 1955 a case was reported from Germany (1 1) and in 1959 two from France (5,6). All these persons had taken a large dose of insulin with suicidal intent.…”

“…The o t h e r non-diabetic took 500 I. U. of p r o t a m i n e zinc a n d 200 I. U. of regular insulin, yet despite this dose did n o t become comatose until 24 hours later. After regaining consciousness, he relapsed i n t o coma a short time afterw a r d s (6).…”